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CONSERVATIVE MANAGEMENT OF PARAVAGINAL HEMATOMA SECONDARY TO
ANTERIOR PROLIFT SURGERY : A CASE REPORT
H. BRAUN1, C. RONDINI 1, F. JORDAN 1, S. AROS 2, C. DESCOUVIERES 1, F. TRONCOSO 1;
1Departamento de Ginecología, Unidad de gestión clínica de la mujer y el recién nacido, Hosp. Padre
Hurtado, Facultad de Med. Clínica Alemana – Univ. del Desarrollo, Santiago, Chile, 2Matrona de
Uroginecologia, Departamento de Ginecología, Unidad de gestión clínica de la mujer y el recién nacido,
Hosp. Padre Hurtado, Facultad de Med. Clínica Alemana – Univ. del Desarrollo, Santiago, Chile.

Objective: To report a case of conservative management of paravesical hematoma secondary to anterior
Prolift.
Background: Because up to one third of the patients operated of genital prolapse might require new
surgery due to relapse, during the last years we have seen the development of new surgical techniques and
prosthetic Kits that look for better results. Nevertheless, the popularity these have gained has also allowed
us to witness the new complications related either to their use or to the learning curve of surgeons with
less experience or of beginners in this type of surgery. Hematomas are infrequent, appearing in the
different series with rates of about 1% frequency.
Methods: BRL, 55 years old , POP stage 3 Ba. In November 2008 she was submitted to surgery for
anterior Prolift which was performed with no major intraoperative complications , presenting hypogastric
pain 5 hours postoperative time. An 8cm tumor was palpated upon physical examination. The abdominal
and transvaginal ultrasonography showed a complex ultrasound image of 110 x 60 mm.
Abdomen and pelvis CT scan revealed a left paravesical extraperitoneal hematoma of 12 x 7 x 5 cm that
shifted the uterus and the bladder to the right .
Conclusion: Extraperitoneal hematomas are an infrequent complication of the use of Kits for prolapse
The patient evolved hemodynamically stable with hematocrit levels after 6 and 48 hours postoperative
time of 31.2% and 32.1% respectively (preoperative hematocrit level of 41%). She was treated with
analgesics and antibiotics (Ceftriaxone 1gr / d + Metronidazol 500 mg ev td for 48 hrs and then
Ciprofloxacin 500mg qd + Metrodinazol 500 mg td until completing 14 days). The patient was
discharged from hospital in good condition the fourth postoperative day for ambulatory treatment and
control. A slow but sustained decrease both of the size of the hematoma and of the pain was observed in
the ambulatory follow-up. So far (3 months follow up) no signs of infection, erosion of the mesh or
relapse have been observed.
repair surgery with prosthetic material. Nevertheless, they must be considered in the differential diagnosis
of patients that evolve with excessive pain, significant decrease of hematocrit levels or hemodynamic
instability in early postoperative time. Conservative management with analgesics and antibiotic
prophylaxis seems to be a safe alternative in hemodynamically stable patients and it seems not to increase
the risk of infection, erosion or relapse.

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